Influence of implantation of a novel domestic prosthetic aortic valve on the functional class of heart failure one year after surgery

Aim. To assess the severity of heart failure (HF) 1 year after aortic valve replacement with a novel bioprosthetic valve with the “easy change” system.Material and methods. The study included 59 patients (24 men and 35 women) diagnosed with degenerative aortic valve disease without concomitant cardiac pathology. The mean age of the patients was 69,6±4,3 years. An assessment of NYHA HF class using six-minute walk test was carried out. The venous plasma level of N-terminal pro-brain natriuretric peptide (NT-proBNP) before and after surgery was also used to determine the severity of HF. In 31 patients (52,5%), NYHA class III HF was determined before surgery.Results. Comparative analysis of HF classes revealed a significant difference. Thus, after implantation of MedEng-BIO prosthetic aortic valve, the distance of the six-minute walk test increased by an average of 125 m (p=0,001). NT-proBNP level decreased from 162,2 pg/ml to 63,7 pg/ml (p=0,003).Conclusion. One-year follow-up of patients after implantation of a novel bioprosthetic aortic valve showed an objective decrease in the severity of HF according to six-minute walk test and NT-proBNP level in venous blood plasma

Влияние инсулинорезистентности на нарушение метаболизма глюкозы в миндалине головного мозга при экспериментальной болезни Альцгеймера

Purpose. Glucose metabolism is tightly regulated in the brain. Aberrant glucose metabolism is an important feature of neurodegenerative diseases, as inAlzheimer’s disease. The transport of glucose to the cell membrane is realized through the activity of insulin-regulated aminopeptidase (IRAP) which controls transfer of glucose transporter to the plasma membrane. IRAP is considered as one of the key markers of insulin resistance in Alzheimer’s disease. However, the question of the mechanism of the action of the IRAP remains open. The aim of the study was to study the effect of IRAP expression on cells of the neuronal and glial lineage, glucose transporter (GLUT4) expression in the brain amygdala on emotional memory in animals with experimental Alzheimer’s disease.Materials and methods. The study was performed with two experimental models of Alzheimer’s disease in mice. The experimental group was mice of the CD1 line, males aged 4 months (Alzheimer’s disease model with the intra-hippocampal administration of beta-amyloid 1-42 (1 µl) bilaterally in the CA1 area). The control group was mice of the CD1 line, males aged 4 months (sham-operated animals with the intrahippocampal administration of Phosphate buffered salin (1 µl) bilaterally in the CA1). The genetic model of Alzheimer’s disease is the B6SLJ-Tg line mice (APPSwFlLon, PSEN1*M146L*L286V) 6799Vas, males aged 4 months. The control group consisted of C57BL/6xSJL mice, males aged 4 months. Evaluation of emotional memory was carried out using “Fear conditioning” protocol. Expression of molecule-markers of insulin-resistance in the amygdala was studied by immunohistochemistry followed by confocal microscopy.Results. Aberrant associative learning and emotional memory was revealed in animals with an experimental model of Alzheimer’s disease. A decrease (p ≤ 0,05) of IRAP expression on cells of neuronal and glial nature, associated with GLUT4 down-regulation was detected in amygdala of brain in animals with experimental Alzheimer’s disease.Conclusion. Decreased number of IRAP-immunopositive neuronal and astroglial cells, as well as IRAP+/ GLUT4+ in cells of amygdala in animals with an experimental model of Alzheimer’s disease, indicates the development of insulin resistance in amygdala of brain, which was in correlation with the hippocampus in performing cognitive functions and memorizing associated with emotionally colored events. Цель. В головном мозге метаболизм глюкозы четко регулируется, поэтому его нарушение является важной особенностью нейродегенеративных заболеваний, в частности болезни Альцгеймера. Транспорт глюкозы в мембрану клетки реализуется за счет активности инсулин-регулируемой аминопептидазы (IRAP), которая влияет на память и обучение, и рассматривается как один из ключевых маркеров инсулинорезистентности при болезни Альцгеймера. Однако вопрос о механизме действия IRAP остается открытым. Цель исследования – изучение влияния экспрессии IRAP на клетках нейрональной и глиальной природы, а также совместно с инсулинзависимым глюкозным транспортером (GLUT4) в миндалине головного мозга на эмоциональную память у животных с экспериментальной болезнью Альцгеймера.Материал и методы. Исследование проводили на животных с использованием двух экспериментальных моделей болезни Альцгеймера – инъекционной и генетической. Опытная группа – мыши линии CD1, самцы в возрасте 4 мес, которым билатерально вводили бета-амилоид 1-42 в зону гиппокампа CA1 (сornu аmmonis)по 1 мкл. Контрольная группа – мыши линии CD1, самцы в возрасте 4 мес, которым билатерально вводили растворитель для бета-амилоида – фосфатно-солевой буфер в зону CA1 по 1 мкл.Генетическая модель болезни Альцгеймера – мыши линии B6SLJ –Tg(APPSwFlLon,PSEN1*M146L*L286 V)6799Vas, самцы в возрасте 4 мес. Контрольная группа – мыши линии C57BL/6xSJL, самцы в возрасте 4 мес. Оценку эмоциональной памяти проводили с использованием нейроповеденческого тестирования Fear conditioning. Экспрессию молекул-маркеров инсулинорезистентности в миндалине изучали методом иммуногистохимии с последующей конфокальной микроскопией.Результаты. У животных с экспериментальной моделью болезни Альцгеймера выявлено нарушение ассоциативного обучения и эмоциональной памяти. Выявлено снижение (р ≤ 0,05) экспрессии IRAP на клетках нейрональной и глиальной природы, а также (совместно с GLUT4) в миндалине головного мозга у животных с экспериментальной болезнью Альцгеймера.Заключение. Уменьшение числа IRAP-иммунопозитивных нейрональных и астроглиальных клеток, а также экспрессии IRAP/GLUT4 в клетках миндалины у животных с экспериментальной моделью болезни Альцгеймера указывает на развитие инсулинорезистентности в миндалине головного мозга, находящейся во взаимосвязи с гиппокампом при осуществлении когнитивных функций и запоминания, сопряженных с эмоционально окрашенными событиями.

Особенности пролиферации и миграции клеток головного мозга при когнитивном тренинге животных с экспериментальной болезнью Альцгеймера

Aims. Alzheimer’s disease is a multifactorial neurodegenerative disease characterized by the presence of amyloid beta peptide containing plaques, and neurofibrillary tangles. Beta-amyloid is a major risk factor and it plays a central role in the onset and progression of Alzheimer’s disease. However, question of the influence of beta-amyloid on neurogenesis in the hippocampus in the adult brain is still open. The purpose of this paper is to study cognitive functions and their association with proliferation, survival and migration of newly-formed cells in normal adult rat brain and in the experimental Alzheimer’s disease.Materials and methods. Rats (Wistar, males, 7 months) were used. Experimental group (Alzheimer’s disease model with the intrahippocampal administration of beta-amyloid 1-42 (5 µl) bilaterally in the CA1 area) and a control group (sham-operated animals with the intrahippocampal administration of Phosphate buffered salin (5 µl) bilaterally in the CA1) have been tested. The study was conducted from February to July. Neurobehavioral test (Morris water maze) was used to assess working memory and memory consolidation. The study of cell migration was performed by introducing bromodeoxyuridine (50 mg/kg). Expression of neurogenesis markers in the subgranular zone of the dentate gyrus of the hippocampus was studied has been studied with indirect immunohistochemistry for free-floating sections followed by the confocal microscopy.Results. Modelling of Alzheimer’s disease leads to impaired cognitive function and memory in animals. We found that these events were associated with the suppression of proliferative (р = 0,043) and migratory activity of brain cells (р = 0,031), but not survival of cells (p = 0,985) compared to the control group.Training in Morris water maze of animals with experimental Alzheimer’s disease promotes migration of progenitor cells along the rostral migration way (р = 0,011) compared with the group without training. However, the number of neuroblasts (р = 0,809) and proliferation of neuronal progenitor cells (p = 0,083) were not significantly affected compared with the group without training.Conclusions. Decreased level of brain cells proliferation, alterations in their migration and development of cognitive dysfunction have been found in the rat model of Alzheimer’s disease, thus suggesting impairment of neurogenesis induced by amyloid. Possible involvement of local insulin resistance into the development of neurogenesis alterations is discussed.Болезнь Альцгеймера является многофакторным нейродегенеративным заболеванием, характеризующимся наличием бета-амилоидных бляшек и нейрофибриллярных клубков. Бета-амилоид является важным фактором риска и играет центральную роль в возникновении и прогрессировании болезни Альцгеймера. Однако вопрос о влиянии бета-амилоида на гиппокампальный нейрогенез во взрослом мозге остается открытым.Цель исследования – изучение влияния процесса обучения на нейрогенез, пролиферацию, выживаемость и миграцию клеток в норме и при экспериментальной болезни Альцгеймера.Материал и методы. Исследование выполнено на самцах зрелых крыс линии Wistar в возрасте 7 мес. Опытная группа – животные с экспериментальной болезнью Альцгеймера после введения бета-амилоида 1-42 в CA1 зону гиппокампа билатерально по 5 мкл. Контрольная группа – ложно-оперированные животные, которым вводили растворитель для бета-амилоида – фосфатно-солевого буфера – в CA1 зону билатерально по 5 мкл. Для оценки рабочей памяти, а также консолидации памяти использовали нейроповеденческое тестирование в водном лабиринте Морриса. Изучение миграции клеток осуществляли путем введения бромдезоксиуридина (50 мг/кг). Экспрессию молекул-маркеров нейрогенеза (Ki-67, PSA-NCAM, PCNA) в гиппокампе исследовали методом иммуногистохимии с последующей конфокальной микроскопией.Результаты. Показано, что моделирование болезни Альцгеймера приводит к нарушениям когнитивных функций и запоминания у животных. В группе с экспериментальной болезнью Альцгеймера выявлено снижение уровня пролиферации клеток (р = 0,043), нарушение миграции (р = 0,031), но не выживаемости клеток (р = 0,985) по сравнению с контрольной группой. Обучение в водном лабиринте Морриса животных с экспериментальной болезнью Альцгеймера способствует миграции клеток-предшественников по ростральному миграционному пути (р = 0,011). Количество нейробластов (р = 0,809) и пролиферация клеток-предшественников нейронов (р = 0,083) значимо не меняется по сравнению с группой без обучения.Заключение. При моделировании болезни Альцгеймера у животных наблюдается когнитивная дисфункция, снижение уровня пролиферации и миграции клеток, что свидетельствует о нарушении нейрогенеза за счет токсического действия амилоида. Обсуждается связь полученных результатов с механизмами развития локальной инсулинорезистентности

Myocardial infarction in the population of some Russian regions and its prognostic value

Aim. To study the prevalence of myocardial infarction (MI) in the population of Russian regions and its contribution to cardiovascular events.Material and methods. The analysis material was representative samples of the population aged 35-64 years from 11 Russian regions,  examined within the multicenter study “Epidemiology of Cardiovascular Diseases and their Risk Factors in Regions  of Russian Federation”. The response rate was about 80%. The study used a community-based  systematic stratified multiply random sample. During the study, information on prior MI was obtained using a standard questionnaire. Anthropometry and measurement of blood pressure (BP) and heart rate (HR) with an automatic BP monitor were performed. Resting electrocardiography (ECG) was performed, followed by Minnesota coding. Major and minor QQS waves and STT segments were considered as ischemic  ECG abnormalities. Biochemical parameters were determined using an Arkhitect 000 Clinical Chemistry Analyzer. The median prospective  follow-up was 6,21 [5,25; 6,75] years. A composite endpoint (CE) was analyzed, including cardiovascular death and non-fatal MI. During the follow-up period, 363 all-cause deaths were detected,  of which 134 were from cardiovascular diseases, while 196 — CEs. Statistical analysis was carried out in R 3.6.1 environment.Results. The MI prevalence among the Russian population was 2,9%; 5,2% for men and 1,5% for women,  increasing  with age. Men with prior MI were  more likely to take statins and beta-blockers  than women as follows: 39,0% vs 25,6% and 29,3% vs 27,1%, respectively. MI newly diagnosed within the follow-up  period was associated with the following risk factors (RFs): smoking, increased BP, HR, triglycerides and glucose.  For individuals with prior MI, a significant relationship was found only with smoking.  Multiple comparison  of the contribution of RFs, ECG abnormalities,  and prior MI showed  that the inclusion of ischemic ECG abnormalities in the analysis significantly increases  the risk of cardiovascular events in individuals without prior MI compared with individuals without both MI and ECG changes.  A high CE risk was noted in patients with prior MI: relative risk (RR), 4,73 (2,92-7,65); the addition of ischemic ECG abnormalities increased the RR to 5,75 (3,76-8,8).Conclusion. The RR of CEs in patients  with prior MI without or with ischemic ECG changes  is 4,73 and 5,75 times higher than in patients without MI and ECG abnormalities. The risk factors  identified  in this case cannot explain such an increase  in CEs. It is obvious  that people  with prior MI need  rehabilitation. The presence of RFs in patients with newly diagnosed  MI indicates insufficient primary prevention, which suggests  that strengthening preventive measures to eliminate conventional risk factors in patients with newly diagnosed  MI will help reduce the risk of recurrent MI or cardiovascular  mortality

CarotidSCORE.RU — risk stratification for complications after carotid endarterectomy

Aim. To demonstrate the first Russian computer program (carotidscore.ru) for risk stratification of postoperative complications of carotid endarterectomy (CE).Material and methods. The present study is based on the analysis of a multicenter Russian database including 25812 patients after CE operated on from January 1, 2010 to April 1, 2022. The following types of CE were implemented: conventional CE with patch angioplasty — 6814 patients; eversion CE — 18998 patients. Following postoperative complications were assessed during the study: death, stroke, myocardial infarction (MI), composite endpoint (death + stroke + MI).Results. During inhospital postoperative period, 0,18% of participants died, while 0,14% had MI, 0,35% — stroke. The composite endpoint was recorded in 0,68%. For each factor present in patients, a predictive coefficient was estimated. The predictive coefficient was considered as a numerical parameter reflecting the strength of the effect of each factor on the development of postoperative complications. Based on this equation, predictive coefficients were calculated for each factor present in patients in our study. The total contribution of these factors was reflected as a percentage and denoted the risk of postoperative complications with a minimum of 0% and a maximum of 100%. On the basis of obtained calculations, a CarotidSCORE program was created. Its graphical interface is based on the QT framework. It is possible not only to estimate the risk of a complication, but also to save all data about a patient in JSON format. The CarotidSCORE program contains 47 patient parameters, including clinical, demographic, anamnestic and angiographic characteristics. It makes it possible to choose one of the four CE types, which will provide an accurate stratification of the complication risk for each of them.Conclusion. CarotidSCORE (carotidscore.ru) may determine the probability of postoperative complications in patients undergoing CE

EXPRESSION OF GENES RESPONSIBLE FOR MULTIDRUG RESISTANCE IN RELAPSED/REFRACTORY MULTIPLE MYELOMA PATIENTS

Background: Multidrug resistance (MDR) is a natural phenomenon in development of solid and hematologic tumors. This phenomenon significantly influences both immediate and remote outcome of treatment. In this connection, an interest arises to studying this problem in multiple myeloma (MM) patients with expressed clinical signs of tumorous progression, the main of them being an absence or loss of the response to antitumor treatment. Aim: To study the expression of messenger RNA (mRNA) of a series of MDR genes, namely MDR1, MRP1, LRP, BCRP responsible for MDR development in the bone marrow aspirate of resistant patients prior to bortezomib-containing chemotherapy. Materials and methods: Study group included 19 relapsed/refractory multiple myeloma patients. Investigation of MDR genes expression was carried out on the cells of the bone marrow mononuclear fraction containing plasmocytes. The mRNA level was analyzed by semiquantitative RT-PCR (polymerase chain reaction with reverse transcription). Patients were treated with bortezomib-containing chemotherapy hereafter. Results: mRNA expression of genes MDR1, MRP1, BCRP was revealed in all (100%) patients, and that of gene LRP – in 81% of myeloma samples. The levels of MDR genes mRNA expression were different. On this basis, two groups of patients were identified: with the levels of MDR genes expression above and beyond the average. Conclusion: 100%-expression of MDR genes (MDR1, MRP1, BCRP) mRNA was revealed in drug resistant MM patients. The median survival in group of patients with higher levels of MDR genes mRNA expression versus lower levels of MDR genes mRNA expression was statistically significant

The effect of insulin resistance on amygdale glucose metabolism alterations in experimental Alzheimer’s disease

Purpose. Glucose metabolism is tightly regulated in the brain. Aberrant glucose metabolism is an important feature of neurodegenerative diseases, as inAlzheimer’s disease. The transport of glucose to the cell membrane is realized through the activity of insulin-regulated aminopeptidase (IRAP) which controls transfer of glucose transporter to the plasma membrane. IRAP is considered as one of the key markers of insulin resistance in Alzheimer’s disease. However, the question of the mechanism of the action of the IRAP remains open. The aim of the study was to study the effect of IRAP expression on cells of the neuronal and glial lineage, glucose transporter (GLUT4) expression in the brain amygdala on emotional memory in animals with experimental Alzheimer’s disease.Materials and methods. The study was performed with two experimental models of Alzheimer’s disease in mice. The experimental group was mice of the CD1 line, males aged 4 months (Alzheimer’s disease model with the intra-hippocampal administration of beta-amyloid 1-42 (1 µl) bilaterally in the CA1 area). The control group was mice of the CD1 line, males aged 4 months (sham-operated animals with the intrahippocampal administration of Phosphate buffered salin (1 µl) bilaterally in the CA1). The genetic model of Alzheimer’s disease is the B6SLJ-Tg line mice (APPSwFlLon, PSEN1*M146L*L286V) 6799Vas, males aged 4 months. The control group consisted of C57BL/6xSJL mice, males aged 4 months. Evaluation of emotional memory was carried out using “Fear conditioning” protocol. Expression of molecule-markers of insulin-resistance in the amygdala was studied by immunohistochemistry followed by confocal microscopy.Results. Aberrant associative learning and emotional memory was revealed in animals with an experimental model of Alzheimer’s disease. A decrease (p ≤ 0,05) of IRAP expression on cells of neuronal and glial nature, associated with GLUT4 down-regulation was detected in amygdala of brain in animals with experimental Alzheimer’s disease.Conclusion. Decreased number of IRAP-immunopositive neuronal and astroglial cells, as well as IRAP+/ GLUT4+ in cells of amygdala in animals with an experimental model of Alzheimer’s disease, indicates the development of insulin resistance in amygdala of brain, which was in correlation with the hippocampus in performing cognitive functions and memorizing associated with emotionally colored events

LONG-TERM RESULTS OF TARGET THERAPY WITH FIRST AND * SECOND-LINE TYROSINE KINASE INHIBITORS IN PATIENTS WITH CHRONIC MYELOID LEUKEMIA

Aim: To assess long-term efficacy of firstand second-line tyrosine kinase inhibitors in non-selected patients with chronic myeloid leukemia in a real-life clinical setting.Materials and methods: The assessment is based on long-term results of a prospective single center comparative clinical trial that was based on non-selected groups of 116 patients with various stages of chronic myeloid leukemia being treated with a first generation tyrosine kinase inhibitor imatinib, and of 44 patients being treated with a second generation tyrosine kinase inhibitor nilotinib. We analyzed all-cause mortality, progression-free survival from April 2005 to April 2013, with a median of the follow-up of 128 months.Results: In 116 patients with chronic myeloid leukemia treated with imatinib, the Kaplan-Meier survival estimate was 120 months. In 44 patients at an early chronic phase, 5-year overall survival and progression-free survival was 93.2% and 8-year overall and progression-free survival was 79.5%. In 44 patients at a late chronic stage, 5-year overall and progression-free survival was 95.5%, 8-year overall and progression-free survival, 72.7%. In 28 patients at acceleration phase, 5-years overall survival was 78.6% and 8-year overall survival, 46%. Median of overall survival in patients treated with nilotinib was not reached. During 78.6 months of combination treatment with cytotoxic agents, tyrosine kinase inhibitors of the first (imatinib) and second line (nilotinib), overall survival was 100%.Conclusion: In clinical practice, inclusion of patients with chronic myeloid leukemia and imatinib resistance (disease relapse) or imatinib intolerance into the treatment program with frontline therapy with general cytotoxic agents and thereafter with firstand second-line tyrosine kinase inhibitors significantly improves overall survival